Materiały źródłowe

• #1 Stroke – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-20350119

  The fast acronym, F.A.S.T., is a good way of remembering stroke symptoms and what to do if you or a friend or loved one experiences those symptoms. […] The brain cells are affected very quickly after a stroke occurs. In the most common type of stroke, called an ischemic stroke, or cerebral infarction, there’s a lack of blood flow to an area of the brain leading the brain cells to begin to die off due to a lack of oxygen and other nutrients. Emergency treatments can sometimes be used to restore the blood flow. Stroke treatments are most effective if they can be used early after stroke symptoms occur. […] Most strokes are preventable. And stroke prevention is far more effective than trying to treat a stroke after it has occurred. […] If stroke symptoms occur, seek emergency care. Work with your medical team to arrange for the appropriate evaluation to clarify why the stroke happened, and institute strategies to prevent another stroke from occurring in the future.

• #1 Acute Stroke Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0600/p616.html

  Rapid diagnosis and prompt treatment of stroke with consideration for use of recombinant tissue plasminogen activator (rtPA) can significantly reduce mortality and morbidity; risk factor modification can reduce recurrence. […] Standardized stroke scoring systems should be used to determine severity of injury and prognosis. The National Institutes of Health Stroke Scale (NIHSS) is the most widely used clinical tool. NIHSS scores generally reflect the degree of stroke severity: mild (8 or less), moderate (9 to 15), and severe (16 or more). […] The initial evaluation includes appropriate radiologic and laboratory evaluation. A glucose test is required before administration of rtPA. Additional tests may be indicated by clinical presentation and history. […] While initial laboratory work is being evaluated, noncontrast computed tomography (NCCT) of the brain should be performed promptly for all patients with stroke symptoms to evaluate for initiation of rtPA therapy.

• #1 Stroke – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/stroke

  A stroke occurs when blood flow to a part of the brain is interrupted as a result of a broken or blocked blood vessel. […] Because treatment depends on the type of stroke, your doctor may use head CT or head MRI to help diagnose your condition. […] The first step in assessing a stroke patient is to determine whether the patient is experiencing an ischemic or hemorrhagic stroke so that the correct treatment can begin. A CT scan or MRI of the head is typically the first test performed. […] Physicians use CT of the head to detect a stroke from a blood clot or bleeding within the brain. […] Physicians use MRI of the head to assess brain damage from a stroke. […] To help determine the type, location, and cause of a stroke and to rule out other disorders, physicians may use blood tests.

• #1 Computed tomography (CT) in stroke diagnosis | STROKE MANUAL

  https://www.stroke-manual.com/computed-tomography-in-stroke-diagnosis/

  Typically, parenchymal changes occur within the first 6 hours, indicating ongoing tissue ischemia (early CT signs of ischemia). […] The earlier these signs are observed, the more severe ischemia can be expected. […] Sensitivity for detecting early signs is ~ 70% (range 20-87%), and specificity is 87% (range 56-100%) the experience of the evaluating physician is crucial. […] Standardized scales have been introduced for MCA territory (ASPECTS) and posterior circulation (PC-ASPECTS). […] The Alberta Stroke Program Early CT Score (ASPECTS) is an essential tool in stroke management, providing a standardized and reliable approach to assessing early ischemic changes. […] ASPECTS primarily evaluates the MCA territory; PC-ASPECTS is designed to evaluate posterior circulation. […] The role of ASPECTS in guiding thrombectomy and intravenous thrombolysis decisions is increasingly refined, supported by advancements in automated scoring. […] ASPECTS is a valuable technique for prognostic evaluation in acute ischemic stroke (thresholds may differ slightly between NCCT and CTP).

• #1 Imaging in Stroke Diagnosis and Treatment: An Update | Applied Radiology

  https://appliedradiology.com/articles/imaging-in-stroke-diagnosis-and-treatment-an-update

  CT angiography (CTA) is an effective method for imaging cerebrovascular anatomy. CTA is recognized to be a highly sensitive (92-100%) and specific (82-100%) method for detecting LVO. […] The concept of mismatch imaging relies on differentiating between the infarct core and the surrounding penumbra based on their imaging characteristics. Identifying a large penumbra may help to salvage it with timely intervention, subsequently reducing the final volume of infarct. […] In summary, rapid, effective, and reliable medical imaging plays a crucial role in the diagnosis and treatment of acute ischemic stroke.

• #1 Diagnosis of Ischemic Stroke: As Simple as Possible

  https://www.mdpi.com/2075-4418/12/6/1452

  The main aims of imaging methods in AIS are: (a) to rule out intracranial hemorrhage and to exclude hemorrhagic stroke as well as contraindications to intravenous thrombolysis (IVT); (b) to identify potential LVO and its localization; (c) to assess/estimate the ischemic core. […] CT is a basic imaging method in the diagnostic workflow of stroke patients. […] NECT has served as the gold standard method for detecting intracranial hemorrhage. […] MRI is also more sensitive than NECT in detecting hemorrhagic transformation of infarction. […] The fact that EVT is currently the standard of care in case of AIS with LVO has been stressed previously. […] CT angiography (CTA) is a fast and suitable tool; a disadvantage of CTA is the necessity of intravenous iodinated contrast agent application, which brings potential adverse effects.

• #1 Neuroimaging of Acute Ischemic Stroke: Multimodal Imaging Approach for Acute Endovascular Therapy

  https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2022.03286

  The main goal of perfusion imaging in patients with AIS is to identify patients with small regions of critical hypoperfusion (often termed ischemic core), which is commonly estimated using a relative cerebral blood flow (rCBF) threshold of 30% of that in normally perfused brain tissue. Differentiating the ischemic core from the surrounding penumbra is crucial for tailoring treatment strategy for patients with AIS. […] Perfusion imaging increases the diagnostic accuracy for acute stroke and provides prognostic information regarding functional outcome. […] The presence of a favorable perfusion profile (mismatch between small rCBF 30% volume and large Tmax 6 seconds lesion or severe clinical presentation) indicates that rapid reperfusion is likely to salvage substantial brain tissue and was the basis of selection in the DAWN, DEFUSE-3, and EXTEND trials that extended EVT and intravenous thrombolytic beyond standard time windows. […] In the late window, the decision for intravenous thrombolysis should be based on advanced imaging modalities. Patients with LVO and target mismatch as assessed by multimodal imaging and/or clinical imaging mismatch should receive EVT.

• #1 Stroke – Diagnosis | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/stroke/diagnosis

  Your doctor will diagnose a stroke based on your symptoms, your medical history, a physical exam, and test results. […] Imaging tests look at the blood vessels in your brain. These images will help determine what type of stroke you had and exactly where it happened in your brain. The faster these tests can be done, the better your doctor can diagnose and treat you. […] Computed tomography (CT) uses X-rays to take clear, detailed pictures of your brain. It is often done right after a suspected stroke. A brain CT scan can show whether there is bleeding in the brain or damage to the brain cells from a stroke. […] Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of your brain. An MRI may be used instead of or in addition to a CT scan to diagnose a stroke. This test can identify changes in brain tissue and damage to brain cells.

• #1 Ischemic Stroke Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/ischemic-stroke

  An ischemic stroke occurs when a blocked vessel prevents blood and therefore oxygen and nutrients from reaching the cells and tissues of the brain; without blood flow, damage to brain cells can occur quickly. […] Our physicians are experienced in medical and surgical stroke treatments that may mitigate effects of stroke and aid in prevention of future strokes. […] To diagnose a stroke, doctors will order an imaging test like computed tomography (CT) or magnetic resonance imaging (MRI) to be performed immediately. CT and MRI scans are both non-invasive means of producing images of the body’s tissues. […] Further testing depends on the outcome of the initial scans. Possible tests include: Carotid duplex scanning, which uses two kinds of sound waves to form pictures of the carotid arteries and provide information about blood flow; Digital subtraction angiography, which uses a computer and a special dye to form images of blood vessels in the brain; Single-photon emission CT (SPECT), which uses a CT scan to create 3-D images that can show which brain areas are suffering from lack of oxygen; Diffusion-weighted imaging (DWI), which uses an MRI to detect brain areas that are swollen and injured; Blood tests to check clotting, blood sugar, toxins, organ function and/or other factors.

• #1 Smartphone App That Could Revolutionize Stroke Diagnosis

  https://read.houstonmethodist.org/smartphone-app-that-could-revolutionize

  Houston Methodist and Pennsylvania State University Collaborate on a Smartphone App That Could Revolutionize Stroke Diagnosis […] Diagnosing a stroke quickly in the Emergency Department (ED) is crucial. With each passing minute that a stroke goes undiagnosed and treated, millions of neurons are lost, and the time for providing the best treatment options available passes. […] The most effective diagnostic tool for ischemic stroke is the MRI, but it is limited by patient cooperation, prolonged turn-around time and delaying treatment. […] An Intelligent Augmented Lifelike Avatar App for Virtual Physical Examination of Suspected Strokes […] To meet this diagnostic challenge, John J. Volpi, MD, Director, Eddy Scurlock Stroke Center and Associate Professor of Clinical Neurology, and his team developed an effective and rapid stroke diagnostic tool.

• #1 American Academy of Neurology: Neurology Resources | AAN

  https://www.aan.com/PressRoom/Home/PressRelease/849

  Doctors should use a diffusion MRI scan to diagnose stroke instead of a CT scan, according to a new guideline from the American Academy of Neurology. […] The guideline found that MRI scans are better at detecting ischemic stroke damage compared to CT scans. […] According to the guideline, diffusion MRI should be considered more useful than a CT scan for diagnosing acute ischemic stroke within 12 hours of a persons first stroke symptom. […] In one large study, among others, that was reviewed for the guideline, stroke was accurately detected 83 percent of the time by MRI versus 26 percent of the time by CT. […] The guideline found MRI scans more accurately detected lesions from stroke and helped identify the severity of some types of stroke or diagnose other medical conditions with similar symptoms. […] This guideline gives doctors clear direction in using MRI first, ultimately helping people get an acute stroke diagnosis and treatment faster.

• #1

  https://www.gleneagles.com.sg/conditions-diseases/stroke/diagnosis-treatment

  How is stroke diagnosed? […] Diagnostic tests for a stroke include: […] Physical examination. Your doctor will ask about your medical history, and check your alertness, blood pressure, vision, reflexes, coordination and muscle strength. […] Blood tests. These are performed to check blood glucose and cholesterol levels, identify blood clotting factors, and detect infections. […] Computed tomography (CT). A CT scan of the brain helps to detect bleeding, an ischaemic stroke, a tumour or other medical conditions. […] Magnetic resonance imaging (MRI). It uses magnetic and radio waves to develop detailed images of the brain to see damaged brain tissues. […] Cerebral angiogram. This is performed to get a clear image of the blood vessels in the brain and neck. […] Carotid ultrasound. This detects fatty deposits in carotid arteries (in the neck) that supply blood to the brain and face.

• #1 Ischemic stroke | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ischemic-stroke-2?lang=us

  MRI is more time consuming and less available than CT but has significantly higher sensitivity and specificity in the diagnosis of acute ischemic infarction in the first few hours after onset. […] Often described as an emerging application of point-of-care ultrasonography, use of transcranial Doppler (TCD) sonography has been utilized for the diagnosis of intracranial vessel occlusion, as well as the differentiation between ischemic and hemorrhagic stroke. […] Acute treatment focuses on prompt application of reperfusion therapies: intravenous or (rarely) intra-arterial thrombolysis (e.g. alteplase, tenecteplase); endovascular clot retrieval for large vessel occlusions.

• #1 Common Diagnosis Methods | American Stroke Association

  https://www.stroke.org/en/about-stroke/types-of-stroke/common-diagnosis-methods

  If you show symptoms of a stroke or a transient ischemic attack, also called TIA, warning stroke or a mini-stroke, your doctor will gather information and make a diagnosis. Your diagnosis will be based on: […] Diagnostic tests examine how the brain looks, works and gets its blood supply. They can outline the injured brain area. Most of them are safe and painless and fall into three categories: […] MRI (magnetic resonance imaging) uses a large magnetic field to produce an image of the brain. Like the CT scan, it shows the location and extent of brain injury. The image produced by MRI is sharper and more detailed than a CT scan, so it’s often used to diagnose small, deep injuries. […] Another blood flow test is a medical procedure called angiography (arteriography or arteriogram). This test is like a cardiac catheterization, but the catheter is placed in the brain’s arteries. A special dye is injected into the blood vessels and an X-ray is taken. Angiography gives a picture of the blood flow through the vessels so the size and location of blockages can be evaluated. This test can be especially valuable in diagnosing aneurysms and malformed blood vessels and providing information before surgery.

• #1 How Is Stroke Diagnosed?

  https://www.healthline.com/health/stroke/how-is-stroke-diagnosed

  Prompt diagnosis and care for a stroke is vital. If a doctor suspects a stroke based on medical history and a physical exam, imaging and other tests can help determine the type, location, and severity. […] A stroke is a medical emergency. Early diagnosis and treatment are essential for preventing complications or death. Doctors can use several different tests to help diagnose a stroke. […] Doctors can use several tests to help to diagnose stroke. A medical history and physical exam followed by imaging of the brain can help them identify the type, location, and severity of the stroke and to plan treatment. […] Blood tests can’t diagnose a stroke alone but can provide helpful information about the potential cause of your symptoms. Doctors may also use EKG and lumbar puncture in certain situations. […] Prompt diagnosis and treatment of a stroke is vital in preventing complications. If you suspect that you or another person is having a stroke, call 911 or your local emergency services.

• #1 4. Emergency Department Evaluation and Management of Patients with Transient Ischemic Attack and Acute Stroke | Canadian Stroke Best Practices

  https://www.strokebestpractices.ca/recommendations/acute-stroke-management/emergency-department-evaluation-and-management

  Initial blood work should include electrolytes, random glucose, complete blood count (CBC), coagulation status (INR, aPTT), and creatinine [Strong recommendation; High quality of evidence]. […] Initial brain imaging reveals a hemorrhagic stroke, refer to CSBPR Management of Intracerebral Hemorrhage module for additional information. […] All patients with suspected acute stroke should undergo brain and vascular imaging computerized tomography (CT) or magnetic resonance imaging (MRI) [Strong recommendation; High quality of evidence]. […] Vascular imaging should be performed from arch-to-vertex and include the extra- and intra-cranial circulation to determine eligibility for acute treatment [Strong recommendation; High quality of evidence]. […] All patients with suspected acute ischemic stroke who arrive at hospital within 6 hours who are potentially eligible for intravenous thrombolysis and/or EVT should undergo immediate non-contrast CT (NCCT) combined with CT angiography (CTA) of the head and neck, performed and interpreted without delay [Strong recommendation; High quality of evidence].

• #1 Ischaemic stroke – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000114

  Ischaemic stroke is a leading cause of morbidity and mortality. If you suspect stroke, work rapidly through the initial assessment and aim for quick access to computed tomographic (CT) scan. Early initiation of reperfusion strategies (intravenous thrombolysis or mechanical thrombectomy) within 4.5 hours from onset of symptoms, if not contraindicated, is associated with improved functional outcomes. […] Ischaemic stroke is a clinical diagnosis based on signs and symptoms. A normal CT scan does not rule out a stroke but will rule out intracranial haemorrhage, which must be excluded before starting thrombolysis. […] Intravenous alteplase should be given (if not contraindicated) if treatment is started as soon as possible within 4.5 hours of onset of symptoms AND intracranial haemorrhage has been excluded by imaging. […] Mechanical thrombectomy can be performed in selected patients within 6 to 24 hours of symptoms onset. […] Diagnostic investigations include non-contrast CT head, serum glucose, serum electrolytes, serum urea and creatinine, cardiac enzymes, FBC, ECG, prothrombin time and PTT (with INR).

• #1 How is stroke diagnosed?

  https://womenshealth.gov/heart-disease-and-stroke/stroke/stroke-treatment-and-recovery/how-stroke-diagnosed

  At the hospital, you will probably get at least one imaging test that allows your doctor to see inside your brain, see how much damage was done and where the stroke happened. […] A CT scan can show bleeding in the brain or damage to brain cells. The CT scan also can find other problems that can cause stroke symptoms. […] MRI shows brain changes caused by stroke sooner than a CT scan. MRI also can show any bleeding or blood flow problems. It can rule out other problems such as tumors that can cause symptoms similar to a stroke. […] There is no blood test that can diagnose a stroke. However, in the hospital, your doctor or nurse may do a series of blood tests to learn the cause of your stroke symptoms: […] If your blood clots too quickly, your stroke may have been caused by a clot (ischemic stroke). If your blood clots too slowly, your stroke may have been caused by bleeding (hemorrhagic stroke). […] Your doctor may measure your thyroid hormone levels with a blood test. Having hyperthyroidism raises your risk of atrial fibrillation, which can lead to stroke. […] Your doctor might order these tests to understand your stroke risk better and to determine how to treat your stroke.

• #1 Stroke – Diagnosis | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/stroke/diagnosis

  Your doctor may also order other tests. […] Electrocardiogram (EKG) can help find heart problems that may have led to a stroke. For example, this test can help diagnose atrial fibrillation or a previous heart attack. […] The exam helps your provider determine how severe your stroke was and plan treatment.

• #1 Patient education: Stroke symptoms and diagnosis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/stroke-symptoms-and-diagnosis-beyond-the-basics

  Heart testing — An electrocardiogram (ECG) is performed in most people who are thought to be having a stroke. Because many people with ischemic strokes also have coronary artery disease, there may be a lack of blood flow (called „ischemia”) in the heart during the stroke. In some cases, the person may not be able to tell the clinician that he or she feels chest pain. The ECG will help the clinician to diagnose and treat any heart problems as quickly as possible.

• #1

  https://www.gleneagles.com.sg/conditions-diseases/stroke/diagnosis-treatment

  Echocardiogram. Sound waves are used to create images of the heart to find clots in that may have dislodged and travelled to the brain. […] Treatment for ischaemic strokes […] Treatment methods for ischaemic strokes include thrombolysis and thrombectomy to enable clot-removal: […] Thrombolysis uses medications to dissolve the blood clot, and needs to be administered within 4 and a half hours of experiencing acute stroke symptoms. […] Thrombectomy uses a clot retrieval device to extract the blood clot. The process involves the insertion of the device into an artery in the groin, and moving it towards the brain to extricate the blood clot. It should be done within 6 hours from the onset of stroke symptoms. […] Treatment for haemorrhagic strokes […] Immediate emergency care is critical for haemorrhagic stroke.

• #1 Diagnosis, Treatment and Complications of Stroke | HKU Stroke Eng

  https://www.stroke-en.med.hku.hk/stroke-diagnosis-treated-complications

  Patients who present with acute stroke symptoms are usually directly admitted to an acute medical ward or acute stroke unit and managed by a multidisciplinary team. […] It should also be noted that for every minute that an acute ischaemic stroke is not treated, approximately 1.9 million neurons in the brain are lost. Anyone with sudden onset of stroke symptoms should immediately attend their nearest Accident and Emergency Department so that appropriate treatment can be given within the effective treatment time window.

• #1 Stroke Diagnosis: Exams, Tests, and Treatment

  https://www.webmd.com/stroke/understanding-stroke-treatment

  At the hospital, your doctor will want to rule out other conditions that might cause your symptoms. These could include seizure, migraine, low blood sugar, or a heart problem. […] Your doctor then will need to do blood tests and imaging tests to figure out which type of stroke you might have had. The most common kind is called ischemic stroke. Almost 90% of people who have a stroke have this, and it happens when a clot blocks blood flow. A hemorrhagic stroke is when you have bleeding in your brain. […] Your doctor may put a clot-busting drug called tPA in your arm. You should get it within 3 hours of the stroke. In some situations, you can get it 4.5 hours later. You’ll probably have it while you’re still in the ER. […] If an aneurysm caused your stroke, your doctor may clamp the broken vessel closed or thread a tiny coil through it that helps to keep the blood vessel from bursting again.

• #1 Diagnosis of Acute Stroke | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0415/p528.html

  The NIHSS is a 15-item scale that can be performed in about five minutes. Although it can help distinguish stroke from stroke mimics, its chief use is to reliably evaluate stroke severity to determine whether tissue plasminogen activator administration is appropriate. […] Reliable use of the NIHSS requires training, which can produce excellent inter-rater reliability of scoring across physicians and nurses. […] Studies of missed stroke diagnosis have found weakness and fatigue, altered mental status, syncope, altered gait and dizziness, and hypertensive urgency to be the most common presenting symptoms in patients admitted for a diagnosis other than stroke who were later confirmed to have had a stroke. […] However, in patients presenting with acute vestibular syndrome defined by one hour or more of acute, persistent, continuous vertigo or dizziness with spontaneous or gaze-evoked nystagmus, plus nausea or vomiting, head motion intolerance, and new gait unsteadiness, one-fourth or more have a posterior circulation stroke.

• #1 Acute Stroke Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0600/p616.html

  Determining the appropriate use of rtPA should be the focus of the initial evaluation because the benefit of treatment is time dependent. Once an NIHSS score has been established and an NCCT of the brain has ruled out intracranial bleeding, it must be determined if the patient has any additional contraindications to rtPA therapy. […] Subarachnoid hemorrhage should be considered in patients with sudden onset of a severe atraumatic headache that is described as the worst headache of their life. […] In patients with cerebellar symptoms that are concerning for posterior circulation stroke, such as gait ataxia, limb ataxia, or vertigo, a HINTS (head-impulse, nystagmus, test of skew) examination should be performed to determine a CNS vs. peripheral cause. […] Recent data from multiple randomized trials have shown that patients with large vessel occlusion have significantly better outcomes with endovascular treatment. […] When the initial evaluation is completed, whether or not the patient received rtPA therapy, a full evaluation is necessary to determine the etiology of the stroke.

• #1 Diagnosis of Acute Stroke | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0415/p528.html

  Reliably distinguishing between hemorrhagic and ischemic stroke can be done only through neuroimaging. […] Noncontrast CT is the imaging test of choice for persons with suspected SAH. […] Noncontrast CT has a sensitivity of nearly 100% for detecting subarachnoid blood in the first 72 hours. […] The frequency of misdiagnosis of SAH is about 12%. […] Patients and family members should be educated about stroke symptoms and the need for urgent evaluation.

• #1 Stroke: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5601-stroke

  If you experience an ischemic stroke, your providers will break up or remove the blood clot that caused it. […] Your healthcare providers or surgeon will tell you exactly which treatments are best for you, what to expect and how long it will take to recover. […] A transient ischemic attack (TIA) sometimes called a mini-stroke is like a stroke, but the effects are temporary. These are often warning signs that a person has a very high risk of having a true stroke soon. A person who has a TIA needs emergency medical care as soon as possible. […] Its hard for experts to estimate a stroke survival rate that applies to everyone. Strokes can be fatal, and they can cause permanent disabilities. But theres no one set recovery timeline or outlook thats accurate for everyone. […] Most people take a few months to recover after a stroke. Your provider will tell you what to expect. Theyll help you set recovery goals and expectations that fit your unique health and situation.

• #1 What Is a Stroke? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/stroke/guide/

  You may also receive a blood transfusion with blood clotting factors to stop ongoing bleeding. […] In addition, a hemorrhagic stroke may require an endovascular procedure (accessed through a blood vessel) or surgery to help stop and prevent further bleeding. […] Management of lifestyle-based risk factors may help prevent a stroke. […] If you have already had a transient ischemic attack (TIA), also known as a mini-stroke, or ischemic stroke, your doctor may recommend certain drugs to reduce your stroke risk. […] A transient ischemic attack (TIA), the event known as a mini-stroke, can be the result of a temporary blockage caused by a blood clot in the brain. […] It lasts for a few minutes and doesn’t cause any permanent damage. […] A TIA can be a warning sign of a future stroke. […] As many as 10 to 15 percent of people who experience a TIA will have a major stroke within the next three months, according to the CDC.

• #1 Transient ischemic attack (TIA) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/diagnosis-treatment/drc-20355684

  A prompt evaluation of your symptoms is vital to diagnose the cause of a transient ischemic attack. […] To pinpoint the cause of the TIA and to assess your risk of a stroke, your healthcare professional may rely on the following: […] Your healthcare professional performs a physical exam and a neurological exam. […] You also may be checked for risk factors of a stroke. These include high blood pressure, high cholesterol levels, diabetes and sometimes high levels of the amino acid homocysteine. […] If your healthcare professional suspects that a narrowed carotid artery in the neck may be the cause of your TIA, you may need a carotid ultrasound. […] CT scans of the head use X-ray beams to create a 3D image. […] These tests use a strong magnetic field to create a 3D view of the brain.

• #1

  https://www.nhs.uk/conditions/transient-ischaemic-attack-tia/diagnosis/

  Several tests may be done to confirm a TIA and look for problems that may have caused it. […] Your blood pressure will be checked, because high blood pressure (hypertension) can lead to TIAs. […] You might need blood tests to check whether you have high cholesterol or diabetes. […] An electrocardiogram (ECG) measures your heart’s electrical activity using a number of electrodes (small, sticky patches) attached to your skin. […] An ECG can detect abnormal heart rhythms, which may be a sign of conditions such as where your heart beats irregularly (atrial fibrillation), which can increase your risk of TIAs. […] A carotid ultrasound scan can show if there is narrowing or any blockages in the neck arteries leading to your brain. […] Brain scans are not always necessary if you’ve had a TIA. They’re usually only done if it’s not clear which part of your brain was affected.

• #1 Tests and diagnosis of stroke

  https://www.clinicbarcelona.org/en/assistance/diseases/stroke/tests-and-diagnosis

  Of all the organs, the brain is the most sensitive to a lack of blood supply. Therefore, and in order to preserve brain function, it is vital to diagnose stroke early on and administer a specific treatment to re-establish blood flow and prevent further tissue damage. […] Rapid intervention in the first hours will increase the chance of greater functional recovery while decreasing the sequelae (long-term after-effects) and mortality. […] Stroke Code is an emergency protocol that quickly identifies, reports and transfers patients with a suspected stroke to their reference hospital, where they then undergo an accurate and early diagnosis before receiving the most appropriate treatment for each case. […] Emergency tests are used to diagnose the stroke and determine whether it is an infarction or haemorrhage. The aim is to guide initial treatment and limit the after-effects.

• #1 Stroke. Diagnosis and Therapeutic Management of Cerebrovascular Disease – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-stroke-diagnosis-and-therapeutic-management-articulo-13109919

  The metaanalysis of the Stroke Unit Triallists’ collaboration demonstrated a reduction of 18% in the relative risk in terms of mortality, morbidity and disability, and the benefits were the same for all types of stroke and all age groups. […] The purpose of thrombolytic therapy is to achieve early restoration of arterial flow and preserve the reversibly damaged neuronal tissue in the ischemic penumbra, by means of a relatively safe agent, in order to improve the disease course. […] The United States Food and Drug Administration (FDA) approved the use of recombinant tissue plasminogen activator (rt-PA) as the first-line treatment for ischemic stroke in June 1998. […] The reported benefits are based on the results of the NINDS study, which demonstrated that the use of rt-PA within the first 3 hours produced an absolute increase of 11% to 13% in the number of patients with an excellent outcome.

• #1 Blood Biomarkers for Stroke: Towards Earlier and More Accurate Stroke Diagnosis and Prognosis  | Quanterix

  https://www.quanterix.com/blog-blood-biomarkers-for-stroke-towards-earlier-and-more-accurate-stroke-diagnosis-and-prognosis/

  Figure 1. Plasma BD-Tau levels at day 2 showed higher value in predicting 90-day functional outcome compared with final infarct volume determined by delayed neuroimaging. […] A simple blood test that provides a precise and reliable measurement of biomarkers that aids in stroke diagnosis, predicting severity and prognosis, and guiding treatment decisions will be invaluable for improving stroke care. Monitoring stoke biomarkers can aid not only in diagnosis but in predicting the potential for stroke recurrence, assessing treatment response and identifying patients that would benefit from specific interventions, such as neuroprotective therapies. […] The complex dynamics of biomarker presentation reflect the nuanced pathophysiology of stroke, suggesting a need for comprehensive approaches to enable accurate differential diagnosis, monitoring and appropriate intervention.

• #1 Stroke Diagnostics and Therapeutics Market to Uplift $76.23 Bn by 2034

  https://www.towardshealthcare.com/insights/stroke-diagnostics-and-therapeutics-market-size

  Based on market forecasts, the stroke diagnostics and therapeutics sector will expand from USD 38.03 billion in 2024 to USD 76.23 billion by 2034, experiencing a CAGR of 7.2%. […] Stroke diagnostics and therapeutics focus on quickly identifying and treating strokes to prevent brain damage and improve recovery. […] Advanced imaging, biomarkers, and AI help diagnose strokes, while treatments like clot-busting drugs, thrombectomy, and rehab therapies restore function and enhance patient outcomes. […] To diagnose a stroke and determine its type and location, medical professionals rely on diagnostic tests such as CT and MRI scans. […] Recent advances in AI in MRI are further bringing precision and accuracy to the results. […] Imaging tests focus on examining the blood vessels in the brain, aiding in determining the type and location of a stroke.

• #1 Smartphone App That Could Revolutionize Stroke Diagnosis

  https://read.houstonmethodist.org/smartphone-app-that-could-revolutionize

  The app uses a machine learning algorithm for computer-aided evaluation of facial movement weaknesses and speech in patients to determine the presence of stroke; it emulates the ED triage process using a smartphone. […] The analyzed results of these tasks are then sent to a specified neurologist or stroke specialist for review. […] Their app was 93% correct in detecting a possible stroke compared to the ED physician rate of 71%, and the app was also better at avoiding overdiagnosis with an accuracy of 79% compared with the physicians rate of 73%. […] This rapid stroke assessment app will allow expedited diagnosis of stroke by physicians, and faster delivery of the most effective treatment options. […] Ultimately, this would further reduce the time from stroke onset to effective treatment and significantly improve patient outcomes, increasing the chances of survival and recovery.

• #1 Stroke care – Philips

  https://www.usa.philips.com/healthcare/medical-specialties/stroke-care/diagnosis

  Telestroke program for access to stroke specialists to enhance diagnosis and potentially increase tPA administration during the time-sensitive acute stroke phase. […] Philips CT and MR systems offer fast exams with exceptional image quality for diagnostic confidence. […] In stroke, time is brain and Azurion neuro suite features a 12% reduction in in-lab preparation time supported by ProcedureCards. […] Integration of Nicolab StrokeViewer into workflows reduces the number of undetected large vessel occlusions (LVOs) by 20% and door-to-groin puncture time by 17%. […] Philips is committed to strengthening the stroke care system, helping to build a system that better serves patients across the care journey. […] A health economic analysis published in 2023 in the Journal of NeuroInterventional Surgery shows an innovative approach to the stroke care pathway reduced costs by an average of EUR 2,848 per patient. […] Earlier results from this study demonstrated that a Direct-to-Angio Suite (DTAS) pathway improves clinical outcomes for patients who have suffered a stroke.

• #2 Stroke: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5601-stroke

  A stroke is a medical emergency that happens when something prevents your brain from getting enough blood flow. A blocked blood vessel or bleeding in your brain can cause strokes. […] If you think you or someone youre with is having a stroke, immediately call 911 or your local emergency services number. Strokes are life-threatening and can be fatal. The sooner someone is diagnosed and treated, the more likely it is theyll survive a stroke. Every second counts. […] A healthcare provider will diagnose a stroke using a combination of a neurological exam and tests. Providers in the emergency room may diagnose a stroke if emergency services transport you to the ER. […] Your providers will restore normal blood flow to your brain as fast as possible to limit the risk of permanent brain damage.

• #2 Stroke – Diagnosis | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/stroke/diagnosis

  Your doctor will diagnose a stroke based on your symptoms, your medical history, a physical exam, and test results. […] Imaging tests look at the blood vessels in your brain. These images will help determine what type of stroke you had and exactly where it happened in your brain. The faster these tests can be done, the better your doctor can diagnose and treat you. […] Computed tomography (CT) uses X-rays to take clear, detailed pictures of your brain. It is often done right after a suspected stroke. A brain CT scan can show whether there is bleeding in the brain or damage to the brain cells from a stroke. […] Magnetic resonance imaging (MRI) uses magnets and radio waves to create pictures of your brain. An MRI may be used instead of or in addition to a CT scan to diagnose a stroke. This test can identify changes in brain tissue and damage to brain cells.

• #2 Acute Stroke Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0600/p616.html

  Rapid diagnosis and prompt treatment of stroke with consideration for use of recombinant tissue plasminogen activator (rtPA) can significantly reduce mortality and morbidity; risk factor modification can reduce recurrence. […] Standardized stroke scoring systems should be used to determine severity of injury and prognosis. The National Institutes of Health Stroke Scale (NIHSS) is the most widely used clinical tool. NIHSS scores generally reflect the degree of stroke severity: mild (8 or less), moderate (9 to 15), and severe (16 or more). […] The initial evaluation includes appropriate radiologic and laboratory evaluation. A glucose test is required before administration of rtPA. Additional tests may be indicated by clinical presentation and history. […] While initial laboratory work is being evaluated, noncontrast computed tomography (NCCT) of the brain should be performed promptly for all patients with stroke symptoms to evaluate for initiation of rtPA therapy.

• #2 Stroke – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-20350119

  During a stroke, things move quickly once you get to the hospital. Your emergency team works to learn what type of stroke you’re having. You’ll likely have a CT scan or other imaging test soon after arrival. […] Some of the tests you may have include: A physical exam. A healthcare professional does several tests, including listening to your heart and checking your blood pressure. A neurological exam looks at how a potential stroke is affecting your nervous system. […] Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show bleeding in the brain, an ischemic stroke, a tumor or other conditions. […] Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and a magnetic field to create a detailed view of the brain. The test can detect brain tissue damaged by an ischemic stroke and brain hemorrhages.

• #2 Stroke Diagnosis and Treatment | Brain Institute | OHSU

  https://www.ohsu.edu/brain-institute/stroke-diagnosis-and-treatment

  The OHSU Stroke Program is a national leader in stroke treatment. We offer coordinated care from the onset of stroke through recovery and rehabilitation. […] Rapid diagnosis is crucial in stroke care. Some treatments can be given only within a short time. Our expert 24/7 stroke team uses the latest tests to quickly make a diagnosis and decide the best treatment. […] Specialists do a physical and neurological exam to assess symptoms and health history. They may request blood and other tests. Scans provide precise pictures of brain tissue, blood vessels and blood flow. […] CT scans use X-rays to produce 3D brain images. They help doctors see the type of stroke. […] This advanced imaging test quickly shows the strokes location and how much brain tissue can be saved. […] Angiograms produce detailed images of blood vessels and blood flow.

• #2 Role of imaging in early diagnosis of acute ischemic stroke: a literature review | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text

  https://ejnpn.springeropen.com/articles/10.1186/s41983-021-00432-y

  This article aims to review the role of different imaging methods in the diagnosis of acute ischemic stroke and determine the advantages and disadvantages of each. […] Early signs of ischemic stroke in CT are chiefly described as hypoattenuation, loss of differentiation between the grey and the white matter, parenchymal swelling and edema, hyperattenuation of the MCA (middle cerebral artery), infarction in the territory of the brain-supplying arteries, and cortical sulcal effacement on the affected side. […] The Alberta Stroke Program Early CT Score (ASPECTS) is a quantitative scoring system that evaluates early changes of MCA stroke, based on the topographic involvement of the MCA-supplying territories of the brain. […] MRI is more accurate in ruling out the intracranial hemorrhage and MRI with DWI is more precise in the detection of acute ischemic stroke. However, due to the availability and lower acquisition time, CT is preferred in most healthcare settings.

• #2 Computed tomography (CT) in stroke diagnosis | STROKE MANUAL

  https://www.stroke-manual.com/computed-tomography-in-stroke-diagnosis/

  Typically, parenchymal changes occur within the first 6 hours, indicating ongoing tissue ischemia (early CT signs of ischemia). […] The earlier these signs are observed, the more severe ischemia can be expected. […] Sensitivity for detecting early signs is ~ 70% (range 20-87%), and specificity is 87% (range 56-100%) the experience of the evaluating physician is crucial. […] Standardized scales have been introduced for MCA territory (ASPECTS) and posterior circulation (PC-ASPECTS). […] The Alberta Stroke Program Early CT Score (ASPECTS) is an essential tool in stroke management, providing a standardized and reliable approach to assessing early ischemic changes. […] ASPECTS primarily evaluates the MCA territory; PC-ASPECTS is designed to evaluate posterior circulation. […] The role of ASPECTS in guiding thrombectomy and intravenous thrombolysis decisions is increasingly refined, supported by advancements in automated scoring. […] ASPECTS is a valuable technique for prognostic evaluation in acute ischemic stroke (thresholds may differ slightly between NCCT and CTP).

• #2 4. Emergency Department Evaluation and Management of Patients with Transient Ischemic Attack and Acute Stroke | Canadian Stroke Best Practices

  https://www.strokebestpractices.ca/recommendations/acute-stroke-management/emergency-department-evaluation-and-management

  Initial blood work should include electrolytes, random glucose, complete blood count (CBC), coagulation status (INR, aPTT), and creatinine [Strong recommendation; High quality of evidence]. […] Initial brain imaging reveals a hemorrhagic stroke, refer to CSBPR Management of Intracerebral Hemorrhage module for additional information. […] All patients with suspected acute stroke should undergo brain and vascular imaging computerized tomography (CT) or magnetic resonance imaging (MRI) [Strong recommendation; High quality of evidence]. […] Vascular imaging should be performed from arch-to-vertex and include the extra- and intra-cranial circulation to determine eligibility for acute treatment [Strong recommendation; High quality of evidence]. […] All patients with suspected acute ischemic stroke who arrive at hospital within 6 hours who are potentially eligible for intravenous thrombolysis and/or EVT should undergo immediate non-contrast CT (NCCT) combined with CT angiography (CTA) of the head and neck, performed and interpreted without delay [Strong recommendation; High quality of evidence].

• #2 4. Emergency Department Evaluation and Management of Patients with Transient Ischemic Attack and Acute Stroke | Canadian Stroke Best Practices

  https://www.strokebestpractices.ca/recommendations/acute-stroke-management/emergency-department-evaluation-and-management

  MRI as a first line for imaging can be challenging to obtain urgently in an emergency department setting. […] Patients with a known allergy to contrast dye or with existing renal failure should not be excluded from consideration for EVT. […] Blood pressure should be lowered and sustained below 185/110 while initiating and during IV thrombolysis therapy, and for the next 24 hours for ischemic stroke patients who are eligible for thrombolytic therapy [Strong recommendation; Low quality of evidence]. […] Patients with ischemic stroke not eligible for thrombolytic therapy: Patients with moderate blood pressure elevation (up to 220 mmHg systolic) should not be routinely treated if they are not eligible for thrombolytic therapy [Conditional recommendation; Low quality of evidence]. […] Patients with extreme blood pressure elevation (e.g., systolic BP 220 or diastolic BP 120 mmHg) should be considered for blood pressure lowering therapy if they are not eligible for thrombolytic therapy [Conditional recommendation; Low quality of evidence].

• #2 Neuroimaging of Acute Ischemic Stroke: Multimodal Imaging Approach for Acute Endovascular Therapy

  https://www.j-stroke.org/journal/view.php?doi=10.5853/jos.2022.03286

  Advances in acute ischemic stroke (AIS) treatment have been contingent on innovations in neuroimaging. Neuroimaging plays a pivotal role in the diagnosis and prognosis of ischemic stroke and large vessel occlusion, enabling triage decisions in the emergent care of the stroke patient. Current imaging protocols for acute stroke are dependent on the available resources and clinicians preferences and experiences. […] In this review, we aimed to discuss the various imaging modalities and approaches used in the diagnosis and treatment of AIS. […] Neuroimaging is an integral part of acute stroke management. It can be used to confirm the diagnosis and to guide acute treatment options by excluding acute hemorrhage, confirming vessel occlusion or stenosis, assessing tissue viability with perfusion estimates, and evaluating collateral circulation. […] Recent advances in neuroimaging modalities have helped identify patients who may or may not benefit from endovascular treatment (EVT). Imaging played a critical role in the selection of patients into acute ischemic stroke (AIS) randomized controlled trials (RCTs), both in the early and late windows of patient presentation.

• #2 American Academy of Neurology: Neurology Resources | AAN

  https://www.aan.com/PressRoom/Home/PressRelease/849

  Doctors should use a diffusion MRI scan to diagnose stroke instead of a CT scan, according to a new guideline from the American Academy of Neurology. […] The guideline found that MRI scans are better at detecting ischemic stroke damage compared to CT scans. […] According to the guideline, diffusion MRI should be considered more useful than a CT scan for diagnosing acute ischemic stroke within 12 hours of a persons first stroke symptom. […] In one large study, among others, that was reviewed for the guideline, stroke was accurately detected 83 percent of the time by MRI versus 26 percent of the time by CT. […] The guideline found MRI scans more accurately detected lesions from stroke and helped identify the severity of some types of stroke or diagnose other medical conditions with similar symptoms. […] This guideline gives doctors clear direction in using MRI first, ultimately helping people get an acute stroke diagnosis and treatment faster.

• #2 Diagnosis of Ischemic Stroke: As Simple as Possible

  https://www.mdpi.com/2075-4418/12/6/1452

  MRI is another method that may be used in the evaluation of potential LVO and its localization. […] There are several possibilities for both CT and MRI in the assessment or estimation of potential acute ischemic changes and estimation of the ischemic core. […] CTP is an established method used to evaluate the viability of brain tissue. […] MRI with DWI and T2 FLAIR sequences is definitively the best method in acute ischemic core volume assessment; their sensitivity and specificity have been repeatedly proven. […] The diagnostic possibilities of both imaging methods that may be used in AIS were reviewed. […] However, in comparing the sensitivity and specificity of both non-invasive methods, MRI should be preferred.

• #2

  https://www.beaumont.org/treatments/stroke-diagnosis

  An MRI uses a large magnetic field to produce an image of the brain. Like the CT scan, it shows the location and extent of brain injury. The image produced by MRI is sharp and detailed, so its often used to diagnose small, deep injuries and may help determine a possible cause of the stroke. […] A carotid artery ultrasound may be ordered if your doctor hears an abnormal sound over your carotid artery caused by disturbances in the blood flow. This diagnostic test takes images of the blood flowing through the arteries and it can detect how severe the narrowing is from plaque buildup. […] A cerebral angiography/cerebral arteriography can be performed to diagnose and show the degree of carotid artery stenosis. This test feeds a catheter from your groin, through your aorta and into the carotid artery. An injectable contrast dye is then inserted into the artery while images of the area are captured. This dye allows your doctor to view the arteries in a more enhanced field of view to detect any vessel abnormality.

• #2 Stroke Types & Diagnostic Testing | San Antonio | University Health

  https://www.universityhealth.com/services/brain-and-spine/stroke-care/diagnosis

  Computerized tomography (CT) scan creates a detailed image that can show bleeding in the brain […] Magnetic resonance imaging (MRI) shows changes in brain tissue and cells […] CT arteriogram (CTA) and magnetic resonance arteriogram (MRA) show large blood vessels and location of a blood clot […] Transthoracic and transesophageal echocardiogram look at your heart to determine if there is an abnormality that could have caused a stroke […] Cerebral angiogram gives a detailed view of arteries in your brain and neck […] Carotid ultrasound shows the carotid arteries in the neck, and if there is a buildup of fatty deposits (plaque).

• #2 4. Emergency Department Evaluation and Management of Patients with Transient Ischemic Attack and Acute Stroke | Canadian Stroke Best Practices

  https://www.strokebestpractices.ca/recommendations/acute-stroke-management/emergency-department-evaluation-and-management

  Hypoglycemia should be corrected immediately using local protocols [Strong recommendation; High quality of evidence]. […] Although no optimal glucose target has been identified in the acute stage, it may be reasonable to treat hyperglycemia as per local protocols as this has been associated with increased risk of hemorrhagic transformation when treating with intravenous thrombolysis [Conditional recommendation; Low quality of evidence]. […] All patients with acute ischemic stroke or TIA should have a 12-lead ECG to assess cardiac rhythm and identify atrial fibrillation or flutter or evidence of structural heart disease [Strong recommendation; Moderate quality of evidence]. […] Unless a patient is hemodynamically unstable, ECG should not delay assessment for intravenous thrombolysis and EVT and can be deferred until after a decision regarding acute treatment is made [Strong recommendation; Moderate quality of evidence].

• #2 How is stroke diagnosed?

  https://womenshealth.gov/heart-disease-and-stroke/stroke/stroke-treatment-and-recovery/how-stroke-diagnosed

  At the hospital, you will probably get at least one imaging test that allows your doctor to see inside your brain, see how much damage was done and where the stroke happened. […] A CT scan can show bleeding in the brain or damage to brain cells. The CT scan also can find other problems that can cause stroke symptoms. […] MRI shows brain changes caused by stroke sooner than a CT scan. MRI also can show any bleeding or blood flow problems. It can rule out other problems such as tumors that can cause symptoms similar to a stroke. […] There is no blood test that can diagnose a stroke. However, in the hospital, your doctor or nurse may do a series of blood tests to learn the cause of your stroke symptoms: […] If your blood clots too quickly, your stroke may have been caused by a clot (ischemic stroke). If your blood clots too slowly, your stroke may have been caused by bleeding (hemorrhagic stroke). […] Your doctor may measure your thyroid hormone levels with a blood test. Having hyperthyroidism raises your risk of atrial fibrillation, which can lead to stroke. […] Your doctor might order these tests to understand your stroke risk better and to determine how to treat your stroke.

• #2 Patient education: Stroke symptoms and diagnosis (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/stroke-symptoms-and-diagnosis-beyond-the-basics

  Heart testing — An electrocardiogram (ECG) is performed in most people who are thought to be having a stroke. Because many people with ischemic strokes also have coronary artery disease, there may be a lack of blood flow (called „ischemia”) in the heart during the stroke. In some cases, the person may not be able to tell the clinician that he or she feels chest pain. The ECG will help the clinician to diagnose and treat any heart problems as quickly as possible.

• #2 Diagnosis of Acute Stroke | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0415/p528.html

  The NIHSS is a 15-item scale that can be performed in about five minutes. Although it can help distinguish stroke from stroke mimics, its chief use is to reliably evaluate stroke severity to determine whether tissue plasminogen activator administration is appropriate. […] Reliable use of the NIHSS requires training, which can produce excellent inter-rater reliability of scoring across physicians and nurses. […] Studies of missed stroke diagnosis have found weakness and fatigue, altered mental status, syncope, altered gait and dizziness, and hypertensive urgency to be the most common presenting symptoms in patients admitted for a diagnosis other than stroke who were later confirmed to have had a stroke. […] However, in patients presenting with acute vestibular syndrome defined by one hour or more of acute, persistent, continuous vertigo or dizziness with spontaneous or gaze-evoked nystagmus, plus nausea or vomiting, head motion intolerance, and new gait unsteadiness, one-fourth or more have a posterior circulation stroke.

• #2 Acute Stroke Diagnosis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/35704804/

  Stroke accounts for significant morbidity and mortality and is the fifth leading cause of death in the United States, with direct and indirect costs of more than $100 billion annually. Expedient recognition of acute neurologic deficits with appropriate history, physical examination, and glucose testing will help diagnose stroke and rule out mimicking presentations. The National Institutes of Health Stroke Scale should be used to determine stroke severity and to monitor for evolving changes in clinical presentation. Initial neuroimaging is used to differentiate between ischemic and hemorrhagic stroke or other pathologic processes. If a stroke is determined to be ischemic within four and a half hours of last known well or baseline state, determining the patient’s eligibility for the administration of intravenous recombinant tissue plasminogen activator is necessary to proceed with informed decision-making for diagnostic workup and appropriate treatment options. Additional evaluation with specialized magnetic resonance imaging studies can help determine if patients can receive recombinant tissue plasminogen activator within nine hours of last known well. Subarachnoid hemorrhage should be considered in the differential diagnosis if the patient presents with rapid onset of severe headache. If radiographic imaging is negative for hemorrhage when there is high suspicion for delayed presentation of stroke, a lumbar puncture should be considered for further evaluation. Patients with cerebellar symptoms should be evaluated with a HINTS (head-impulse, nystagmus, test of skew) examination because it is more sensitive for cerebellar stroke than early magnetic resonance imaging. Additional cerebrovascular imaging should be considered in patients with large vessel occlusions presenting within 24 hours of last known well to assess benefits of endovascular interventions. Once initial interventions have been implemented, poststroke evaluations such as telemetry, echocardiography, and carotid imaging should be performed as clinically indicated to determine the etiology of the stroke.

• #2 Diagnosis of Acute Stroke | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0415/p528.html

  Reliably distinguishing between hemorrhagic and ischemic stroke can be done only through neuroimaging. […] Noncontrast CT is the imaging test of choice for persons with suspected SAH. […] Noncontrast CT has a sensitivity of nearly 100% for detecting subarachnoid blood in the first 72 hours. […] The frequency of misdiagnosis of SAH is about 12%. […] Patients and family members should be educated about stroke symptoms and the need for urgent evaluation.

• #2

  https://www.nhs.uk/conditions/transient-ischaemic-attack-tia/diagnosis/

  It’s important to be assessed by a healthcare professional as soon as possible if you think you’ve had a transient ischaemic attack (TIA). […] After an initial assessment, you will be referred to a specialist for further tests to help determine the cause of the TIA. You should be referred to see a specialist within 24 hours of the start of your symptoms. […] If they suspect you’ve had a TIA, you’ll be given aspirin to take straight away to prevent a stroke, unless there’s a medical reason why you cannot take aspirin. You’ll also be referred to a specialist for further tests. […] You’ll usually be seen by a doctor who specialises in conditions that affect the brain and spine (neurologist), or a consultant who specialises in strokes. This may be in a specialist stroke or TIA clinic, or an acute stroke unit.

• #2 Transient ischemic attack (TIA) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/diagnosis-treatment/drc-20355684

  A prompt evaluation of your symptoms is vital to diagnose the cause of a transient ischemic attack. […] To pinpoint the cause of the TIA and to assess your risk of a stroke, your healthcare professional may rely on the following: […] Your healthcare professional performs a physical exam and a neurological exam. […] You also may be checked for risk factors of a stroke. These include high blood pressure, high cholesterol levels, diabetes and sometimes high levels of the amino acid homocysteine. […] If your healthcare professional suspects that a narrowed carotid artery in the neck may be the cause of your TIA, you may need a carotid ultrasound. […] CT scans of the head use X-ray beams to create a 3D image. […] These tests use a strong magnetic field to create a 3D view of the brain.

• #2 Transient ischemic attack (TIA) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/diagnosis-treatment/drc-20355684

  This test may be done to find out if a heart issue caused fragments in the blood that led to a blockage. […] This procedure is used in some people to get a view of arteries in the brain not usually seen in an X-ray. […] Once your healthcare professional learns the cause of the transient ischemic attack, the goal of treatment is to correct the issue and prevent a stroke. […] Several medicines may lower the risk of stroke after a TIA. […] Your healthcare professional may prescribe a direct oral anticoagulant such as apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa) or dabigatran (Pradaxa), which may be safer than warfarin due to lower bleeding risk. […] If the carotid artery in the neck is very narrowed, your healthcare professional may suggest a surgery called carotid endarterectomy.

• #2 Stroke Diagnostics and Therapeutics Market to Uplift $76.23 Bn by 2034

  https://www.towardshealthcare.com/insights/stroke-diagnostics-and-therapeutics-market-size

  The timeliness of these tests is crucial for an accurate diagnosis and effective treatment. […] Various Imaging Techniques are Employed for Stroke Diagnostics: […] The stroke diagnostics and therapeutics market benefits from continuous innovations in imaging technologies, the integration of telemedicine for remote care, and the application of personalized medicine approaches. […] Early diagnosis, enabled by these advancements, is critical in stroke management. […] The time is brain concept underscores the importance of quick action in minimizing brain damage during a stroke, making early diagnosis a cornerstone in effective stroke care. […] The increasing prevalence rate of stroke globally has notably contributed to the growth of the diagnostics and treatment market. […] As a leading cause of long-term disability and mortality, strokes have prompted a heightened focus on early detection and effective intervention.

• #2 Stroke: Signs and Symptoms

  https://www.stroke.org.uk/stroke/symptoms

  Stroke can happen to anyone, of any age, at any time. It’s vital to know how to spot the signs of a stroke in yourself or someone else. […] Stroke is a medical emergency that requires immediate attention as every minute is vital. If you experience or spot any of the below, dont wait. Call 999 straight away. […] The FAST acronym (Face, Arms, Speech, Time) is a test to quickly identify the three most common signs of stroke. […] Acting FAST will give the person having a stroke the best chance of survival and recovery. Even if it doesnt seem like much, any one of these signs of stroke is an emergency, so always call 999 immediately. […] Ambulance paramedics are trained in stroke and will ensure the person receives emergency medical care and specialist treatment. […] If you spot any one of these signs or symptoms, don’t wait. Call 999 straight away. […] If the symptoms only last a short amount of time, it could be a transient ischaemic attack (TIA), also known as a mini-stroke. It is still vital to call 999 and get urgent medical attention. A TIA is a medical emergency and a warning that you are at risk of having a stroke.

• #2 Stroke Treatment, Diagnosis, Tests | Brigham and Women’s Hospital

  https://www.brighamandwomens.org/neurosurgery/cerebrovascular/stroke/treatment

  Strokes are serious medical emergencies. Fast diagnosis and treatment increase the likelihood of a positive outcome. […] The best outcomes require getting treatment within four hours of showing symptoms, so don’t hesitate or „wait and see” if you think you’re having a stroke. […] When you arrive at the hospital, your doctor will diagnose a potential stroke through a variety of tests. The initial diagnostic test for a stroke is a physical exam. Next, they may perform imaging tests to show blood flow in the brain. […] Besides diagnosing a stroke, these advanced imaging tools allow your care team to pinpoint the location of the stroke, determine what kind of stroke you’re having, and identify the best stroke therapy. […] There’s no way to provide a definitive stroke diagnosis without a doctor, but if you suspect someone is having a stroke, the FAST test is a good way to quickly test for stroke.

• #2 Stroke Through the Ages | Stroke Timeline

  https://www.rapidai.com/stroke-timeline

  Tissue plasminogen activator (tPA), a drug that breaks down a clot by dismantling its underlying framework, became the first FDA-approved medical treatment for ischemic stroke. […] With advanced brain imaging analysis powered by artificial intelligence, Rapid provided a sophisticated tool to help physicians quickly identify and diagnose stroke, view how a stroke is developing, and determine whether treatment would be effective. […] The American Heart Association endorsed mechanical thrombectomy as a standard method for treating ischemic stroke up to 6 hours after symptom onset. […] The Rapid imaging system was used for patient selection in two landmark clinical trials, DAWN and DEFUSE 3, which proved that stroke patients could successfully be treated with thrombectomy up to 24 hours after symptom onset.

• #2 Stroke Diagnostics and Therapeutics Market to Uplift $76.23 Bn by 2034

  https://www.towardshealthcare.com/insights/stroke-diagnostics-and-therapeutics-market-size

  Based on market forecasts, the stroke diagnostics and therapeutics sector will expand from USD 38.03 billion in 2024 to USD 76.23 billion by 2034, experiencing a CAGR of 7.2%. […] Stroke diagnostics and therapeutics focus on quickly identifying and treating strokes to prevent brain damage and improve recovery. […] Advanced imaging, biomarkers, and AI help diagnose strokes, while treatments like clot-busting drugs, thrombectomy, and rehab therapies restore function and enhance patient outcomes. […] To diagnose a stroke and determine its type and location, medical professionals rely on diagnostic tests such as CT and MRI scans. […] Recent advances in AI in MRI are further bringing precision and accuracy to the results. […] Imaging tests focus on examining the blood vessels in the brain, aiding in determining the type and location of a stroke.

• #2 Diagnosis of ischemic stroke

  https://www.nature.com/collections/cjaahhfahc

  Strokes occur when there is disruption to the blood supply to a part of the brain. The type of stroke occurring is traditionally diagnosed by imaging of the brain by computed tomography (CT) or magnetic resonance imaging (MRI). […] It is thus important to quickly diagnose the type of stroke occurring, to enable appropriate treatment to be initiated as fast as possible. Around 87% of all strokes are ischemic strokes. […] We encourage submission of manuscripts describing the early detection, prediction or monitoring of ischemic stroke. This includes studies evaluating biomarkers in body fluids, wearables, and imaging methods.

• #2 Imaging in Stroke Diagnosis and Treatment: An Update | Applied Radiology

  https://appliedradiology.com/articles/imaging-in-stroke-diagnosis-and-treatment-an-update

  CT angiography (CTA) is an effective method for imaging cerebrovascular anatomy. CTA is recognized to be a highly sensitive (92-100%) and specific (82-100%) method for detecting LVO. […] The concept of mismatch imaging relies on differentiating between the infarct core and the surrounding penumbra based on their imaging characteristics. Identifying a large penumbra may help to salvage it with timely intervention, subsequently reducing the final volume of infarct. […] In summary, rapid, effective, and reliable medical imaging plays a crucial role in the diagnosis and treatment of acute ischemic stroke.

• #2 New tool can diagnose strokes with a smartphone | Penn State University

  https://www.psu.edu/news/research/story/new-tool-can-diagnose-strokes-smartphone

  A new tool created by researchers at Penn State and Houston Methodist Hospital could diagnose a stroke based on abnormalities in a patients speech ability and facial muscular movements, and with the accuracy of an emergency room physician all within minutes from an interaction with a smartphone. […] The teams novel approach is the first to analyze the presence of stroke among actual emergency room patients with suspicion of stroke by using computational facial motion analysis and natural language processing to identify abnormalities in a patients face or voice, such as a drooping cheek or slurred speech. […] Testing the model on the Houston Methodist dataset, the researchers found that its performance achieved 79% accuracy comparable to clinical diagnostics by emergency room doctors, who use additional tests such as CT scans.

• #2 Stroke: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5601-stroke

  Call 911 (or your local emergency services number) if you think youre experiencing stroke symptoms again. Another stroke has an even higher risk of causing severe complications and being fatal. […] A stroke is a medical emergency. Call for help right away if you think youre having a stroke. Getting diagnosed and treated as soon as possible is the best way to increase your chances of survival and recovery.

• #2 Stroke Through the Ages | Stroke Timeline

  https://www.rapidai.com/stroke-timeline

  The Rapid platform received FDA clearance to identify suspected large vessel occlusions in ischemic stroke patients (Rapid LVO) and to notify physicians of possible intracranial hemorrhage (Rapid ICH), becoming a truly comprehensive solution for both ischemic and hemorrhagic stroke. […] Machine learning and other stroke artificial intelligence (AI) techniques are changing medicine in profound ways.

• #3 Acute Stroke Diagnosis | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0600/p616.html

  Stroke accounts for significant morbidity and mortality and is the fifth leading cause of death in the United States, with direct and indirect costs of more than $100 billion annually. Expedient recognition of acute neurologic deficits with appropriate history, physical examination, and glucose testing will help diagnose stroke and rule out mimicking presentations. The National Institutes of Health Stroke Scale should be used to determine stroke severity and to monitor for evolving changes in clinical presentation. Initial neuroimaging is used to differentiate between ischemic and hemorrhagic stroke or other pathologic processes. If a stroke is determined to be ischemic within four and a half hours of last known well or baseline state, determining the patient’s eligibility for the administration of intravenous recombinant tissue plasminogen activator is necessary to proceed with informed decision-making for diagnostic workup and appropriate treatment options.

• #3 Stroke – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/drc-20350119

  During a stroke, things move quickly once you get to the hospital. Your emergency team works to learn what type of stroke you’re having. You’ll likely have a CT scan or other imaging test soon after arrival. […] Some of the tests you may have include: A physical exam. A healthcare professional does several tests, including listening to your heart and checking your blood pressure. A neurological exam looks at how a potential stroke is affecting your nervous system. […] Computerized tomography (CT) scan. A CT scan uses a series of X-rays to create a detailed image of your brain. A CT scan can show bleeding in the brain, an ischemic stroke, a tumor or other conditions. […] Magnetic resonance imaging (MRI). An MRI uses powerful radio waves and a magnetic field to create a detailed view of the brain. The test can detect brain tissue damaged by an ischemic stroke and brain hemorrhages.

• #3 Diagnosis of Acute Stroke | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0415/p528.html

  The NIHSS is a 15-item scale that can be performed in about five minutes. Although it can help distinguish stroke from stroke mimics, its chief use is to reliably evaluate stroke severity to determine whether tissue plasminogen activator administration is appropriate. […] Reliable use of the NIHSS requires training, which can produce excellent inter-rater reliability of scoring across physicians and nurses. […] Studies of missed stroke diagnosis have found weakness and fatigue, altered mental status, syncope, altered gait and dizziness, and hypertensive urgency to be the most common presenting symptoms in patients admitted for a diagnosis other than stroke who were later confirmed to have had a stroke. […] However, in patients presenting with acute vestibular syndrome defined by one hour or more of acute, persistent, continuous vertigo or dizziness with spontaneous or gaze-evoked nystagmus, plus nausea or vomiting, head motion intolerance, and new gait unsteadiness, one-fourth or more have a posterior circulation stroke.

• #3 Diagnosis | Stroke Association

  https://www.stroke.org.uk/stroke/symptoms/diagnosis

  You should have a brain scan soon after symptoms start, within an hour of arriving at hospital if possible. The scan can show whether the stroke is due to a clot or a bleed. […] The results of your brain scan will help your doctors to identify what may have caused your stroke and ensure you get the right emergency treatment. […] There are a number of other tests that you may receive during your first few days in hospital.

• #3 Ischemic stroke | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ischemic-stroke-2?lang=us

  An ischemic stroke typically presents with rapid onset neurological deficit, which is determined by the area of the brain that is involved. […] Interruption of blood flow through an intracranial artery leads to deprivation of oxygen and glucose in the supplied vascular territory. […] The mechanism of vessel obstruction is important in addressing therapeutic maneuvers to both attempt to reverse or minimize the effects and to prevent future infarcts. […] Non-contrast CT of the brain remains the mainstay of imaging in the setting of an acute stroke. […] The goals of CT in the acute setting are: exclude intracranial hemorrhage, which would preclude thrombolysis; look for any „early” features of ischemia; exclude other intracranial pathologies that may mimic a stroke, such as a tumor. […] CT perfusion has emerged as a critical tool in selecting patients for reperfusion therapy as well as increasing the accurate diagnosis of ischemic stroke among non-expert readers four-fold compared to routine non-contrast CT.

• #3 Ischemic stroke | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/ischemic-stroke-2?lang=us

  MRI is more time consuming and less available than CT but has significantly higher sensitivity and specificity in the diagnosis of acute ischemic infarction in the first few hours after onset. […] Often described as an emerging application of point-of-care ultrasonography, use of transcranial Doppler (TCD) sonography has been utilized for the diagnosis of intracranial vessel occlusion, as well as the differentiation between ischemic and hemorrhagic stroke. […] Acute treatment focuses on prompt application of reperfusion therapies: intravenous or (rarely) intra-arterial thrombolysis (e.g. alteplase, tenecteplase); endovascular clot retrieval for large vessel occlusions.

• #3 Transient ischemic attack (TIA) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/transient-ischemic-attack/diagnosis-treatment/drc-20355684

  A prompt evaluation of your symptoms is vital to diagnose the cause of a transient ischemic attack. […] To pinpoint the cause of the TIA and to assess your risk of a stroke, your healthcare professional may rely on the following: […] Your healthcare professional performs a physical exam and a neurological exam. […] You also may be checked for risk factors of a stroke. These include high blood pressure, high cholesterol levels, diabetes and sometimes high levels of the amino acid homocysteine. […] If your healthcare professional suspects that a narrowed carotid artery in the neck may be the cause of your TIA, you may need a carotid ultrasound. […] CT scans of the head use X-ray beams to create a 3D image. […] These tests use a strong magnetic field to create a 3D view of the brain.

• #3 Stroke Through the Ages | Stroke Timeline

  https://www.rapidai.com/stroke-timeline

  The Rapid platform received FDA clearance to identify suspected large vessel occlusions in ischemic stroke patients (Rapid LVO) and to notify physicians of possible intracranial hemorrhage (Rapid ICH), becoming a truly comprehensive solution for both ischemic and hemorrhagic stroke. […] Machine learning and other stroke artificial intelligence (AI) techniques are changing medicine in profound ways.

• #3 Stroke Treatment, Diagnosis, Tests | Brigham and Women’s Hospital

  https://www.brighamandwomens.org/neurosurgery/cerebrovascular/stroke/treatment

  Strokes are serious medical emergencies. Fast diagnosis and treatment increase the likelihood of a positive outcome. […] The best outcomes require getting treatment within four hours of showing symptoms, so don’t hesitate or „wait and see” if you think you’re having a stroke. […] When you arrive at the hospital, your doctor will diagnose a potential stroke through a variety of tests. The initial diagnostic test for a stroke is a physical exam. Next, they may perform imaging tests to show blood flow in the brain. […] Besides diagnosing a stroke, these advanced imaging tools allow your care team to pinpoint the location of the stroke, determine what kind of stroke you’re having, and identify the best stroke therapy. […] There’s no way to provide a definitive stroke diagnosis without a doctor, but if you suspect someone is having a stroke, the FAST test is a good way to quickly test for stroke.

• #4 How is stroke diagnosed?

  https://womenshealth.gov/heart-disease-and-stroke/stroke/stroke-treatment-and-recovery/how-stroke-diagnosed

  Stroke is a medical emergency. Tests for stroke usually start when you’re in the ambulance, before you get to the hospital. The goals of the tests are to figure out whether you’ve had a stroke, what type of stroke you’ve had, and what caused the stroke. This will help your doctors plan your treatment. […] After you call 911 and the ambulance arrives, an ambulance worker will start the stroke exam. A doctor will continue the exam at the hospital. The ambulance worker or doctor will: […] Do a neurological exam. This test checks how well your nervous system is working to show whether you have had a stroke. In this exam, the doctor will ask you questions, test your reflexes, and ask you to do simple actions. Each part of the exam tests a different part of your brain. This test can show how serious your stroke was and where in your brain the stroke might have happened.

• #4 4. Emergency Department Evaluation and Management of Patients with Transient Ischemic Attack and Acute Stroke | Canadian Stroke Best Practices

  https://www.strokebestpractices.ca/recommendations/acute-stroke-management/emergency-department-evaluation-and-management

  All patients presenting to an emergency department with suspected acute stroke should be immediately assessed and undergo investigations without delay to establish a diagnosis and determine eligibility for thrombolysis and/or endovascular thrombectomy (EVT) [Strong recommendation; High quality of evidence]. […] Patients with suspected acute stroke should have a rapid initial evaluation for airway, breathing, and circulation [Strong recommendation; High quality of evidence]. […] Patients with suspected stroke should be triaged as Canadian Triage Acuity Scale (CTAS) Level 2 in most cases and as CTAS Level 1 for patients with compromised airway, breathing, or cardiovascular function [Strong recommendation; Low quality of evidence]. […] Patients with suspected acute stroke should have a rapid neurological examination to determine focal neurological deficits using a validated scale such as FAST (Face, Arm, Speech, Time) [Strong recommendation; Moderate quality of evidence]; and to assess for stroke severity using a validated screen [Strong recommendation; High quality of evidence].

• #4 Stroke – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/stroke

  A stroke occurs when blood flow to a part of the brain is interrupted as a result of a broken or blocked blood vessel. […] Because treatment depends on the type of stroke, your doctor may use head CT or head MRI to help diagnose your condition. […] The first step in assessing a stroke patient is to determine whether the patient is experiencing an ischemic or hemorrhagic stroke so that the correct treatment can begin. A CT scan or MRI of the head is typically the first test performed. […] Physicians use CT of the head to detect a stroke from a blood clot or bleeding within the brain. […] Physicians use MRI of the head to assess brain damage from a stroke. […] To help determine the type, location, and cause of a stroke and to rule out other disorders, physicians may use blood tests.

• #5 Diagnosis of Acute Stroke | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0415/p528.html

  The NIHSS is a 15-item scale that can be performed in about five minutes. Although it can help distinguish stroke from stroke mimics, its chief use is to reliably evaluate stroke severity to determine whether tissue plasminogen activator administration is appropriate. […] Reliable use of the NIHSS requires training, which can produce excellent inter-rater reliability of scoring across physicians and nurses. […] Studies of missed stroke diagnosis have found weakness and fatigue, altered mental status, syncope, altered gait and dizziness, and hypertensive urgency to be the most common presenting symptoms in patients admitted for a diagnosis other than stroke who were later confirmed to have had a stroke. […] However, in patients presenting with acute vestibular syndrome defined by one hour or more of acute, persistent, continuous vertigo or dizziness with spontaneous or gaze-evoked nystagmus, plus nausea or vomiting, head motion intolerance, and new gait unsteadiness, one-fourth or more have a posterior circulation stroke.

• #6 Diagnosis of Acute Stroke | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0415/p528.html

  The NIHSS is a 15-item scale that can be performed in about five minutes. Although it can help distinguish stroke from stroke mimics, its chief use is to reliably evaluate stroke severity to determine whether tissue plasminogen activator administration is appropriate. […] Reliable use of the NIHSS requires training, which can produce excellent inter-rater reliability of scoring across physicians and nurses. […] Studies of missed stroke diagnosis have found weakness and fatigue, altered mental status, syncope, altered gait and dizziness, and hypertensive urgency to be the most common presenting symptoms in patients admitted for a diagnosis other than stroke who were later confirmed to have had a stroke. […] However, in patients presenting with acute vestibular syndrome defined by one hour or more of acute, persistent, continuous vertigo or dizziness with spontaneous or gaze-evoked nystagmus, plus nausea or vomiting, head motion intolerance, and new gait unsteadiness, one-fourth or more have a posterior circulation stroke.

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